The Go-Between New Look Issue 71 August 2006

http://london.assist.org.uk/resources/resources.htm
The Go-Between
Information for Information Users
Issue 71 August 2006
New Look
alive). A wide range of communication methods should be
used in order to reach everybody.
After 70 issues The Go-Between gets a new look, but the
aim remains the same – to promote the use of information
in the health sector.
Change Management & Transformation
Early Trust engagement in change management activities
is strongly advised, ensuring that appropriate change
management resources are in place to enable Trusts to
achieve maximum benefit. Knowledge of the application,
early identification of areas impacted and opportunities for
change and improvement are essential in starting this
work. Trust’s benefits plans should be widely publicised
and understood.
The Go-Between would like to hear from potential
contributors. Articles should be on IM&T related matters
and around 250-400 words in length. Copy deadline for
Issue 72 is 20 September 2006.
For contributions etc. please write to the Editor
(address on back page).
____________________________________________________
In This Issue
Diary
Learning the Lessons
National Service Desk
News in Brief
Spine Directory Service
Update on HRGs
____________________________________________________
Learning the Lessons
There are many system implementations planned or taking
place under the National Programme for IT. It is worth
considering some of the lessons learned from early
implementations. This article summaries some of the key
points.
Process Re-design
There needs to be sufficient resource to lead process redesign in the project. A test system should be available at
the Trust and staff freed up to look at processes. Involve
trainers, so they understand the reason why a process has
been developed (and so that this can inform the training).
An early review of system user roles is recommended to
ensure compatibility (i.e. job title is not always the same as
job role and how the system needs to be accessed).
Data Migration
Identify a responsible owner in the Trust to manage the
process and the data. Provide a realistic amount of
resources and have realistic time scales for data migration.
Provide access to computers for data input, prioritising and
targeting data for catch-up work.
Training
Identify your target audience for training early on, mapping
the trainees to the system user role. Identify any prerequisite training (e.g. basic computer skills) so this training
can be scheduled before the main system training takes
place. The training approach and course content needs to
be sufficiently integrated with the change management and
business transformation work.
Continued on page 2.
____________________________________________________
Planning and Preparation
Joined-up teams working well from the outset supported by
good communication, information-sharing and problem
resolution are needed from the planning and preparation
stage. Weekly Executive Reviews (highlight reports) and
weekly check points help to keep the project on track.
Project Organisation
Good project organisation lies at the heart of a successful
project. Start by identifying the decision makers. Involve
operational managers as much as possible, ensuring Trust
staff are fully involved. Ensure that the project provides
continuity for a period post go-live. Recognise the range of
full time roles required in the project and develop expertise
by employing a team for the whole of the project.
Communications
Any major system implementation will need significant local
communication support, it is therefore important to work
with the organisation’s communications manager. A high
level of communication needs to be maintained even
through times of uncertainty (in order to keep the interest
To boldly go…..A new national Service Desk is being
put in place – see page 2.
____________________________________________________
Continued from page1.
Make sure there are enough trainers! It is very easy to
underestimate the number required. It is recommend that
trainers spend time on the system to be replaced so that
they understand what the differences are between the “old”
and the “new”. Trainers should also be trained on whole
system, not just specialised areas.
When scheduling training be sure to give plenty of notice to
get courses into clinicians’ diaries. It is important that
training is booked so as to maximise attendance and to
tailor training appropriate to job roles. Build in contingency
to the training plan and monitor progress against the plan.
Schedule a 4 day max training week for trainers with a
maximum of 8 delegates per course. This will enable some
contingency and allow the trainers to participate in other
activities such as preparing course material and
demonstrating the system. Provide regular updates to
trainers on project developments.
“Champion” Users
“Champion” users can be a highly valued resource instilling
confidence in users, but they need to be committed to a
successful deployment. They need early and continuous
exposure to the product prior to “Go-Live”, and must
understand the local Trust-specific training curriculum. A
good grounding in the business process re-design and the
services they are supporting will help them fulfil their role.
The role and mode of operation of the “Champion” user
needs to be clearly understood by all. Training them in
common problems can relieve pressure on the IT Service
Desk.
Service Desk
Trust service desks should be engaged early on in the
discussions around their internal IT support arrangements
(out of hours, 24/7), receive training in the system, be
aware of common problems and frequently asked
questions (FAQs).
Changes prior to, during and post Go-Live
Implementing a new system often involves introducing a
number of associated changes. There is a need for a
coordinated change management approach: in agreeing
those changes and implementation. A forum for rapid,
authoritative decision making, to take a trust-wide view of
issues, priorities and implications can really help here.
Appraise the system 6 months down the track and check
whether the problems staff are experiencing are still real or
are they no longer relevant as users adapt to the system.
More Information: nww.connectingforhealth.nhs.uk/
implementation/Top%20Tips
Contact: [email protected]
______________________________________________
Spine Directory
Services
The NHS Spine Directory Service (SDS) provides the
national directories of organisations, people, sites, GP
Practices, NHS staff and services. This service not only
sets national codes, coding structures and standards but
directories will provide the “glue” to bring together
electronic care records into the national Care Records
Service.
All organisational details within the SDS must be registered
with National Administrative Codes Service (NACS – see
below). NACS supply a data feed directly to the SDS. All
departmental data is created by the organisation’s own
data controller. People are registered to the Spine User
Directory (SUD) by their organisation’s Registration
Authority (RA).
The SDS consists of three main nodes.
The organisation node holds data about the
organisational structure of the NHS. This is a mixture of
the information provided by NACS and the departmental
data created by the administrative users.
The people node holds data about all the users of the
SDS. This data is confirmed during the user registration
process and issuing of authentication smartcards. Each
SDS user has one entry immediately beneath the people
node. A user may have multiple org entries, one for each
org with whom they have a direct association.
The services node holds a read-only copy of data about
all the accredited and registered services using NHS
systems. Each service registered with the SDS has one
entry immediately beneath the services node. This entry
holds the details generic of all the services’ actions.
National Administrative Codes Service (NACS)
The (NACS) is also provided by CfH. It is responsible for
national policy and standards for organisation and
practitioner codes, which form part of the NHS data
standards. CfH is also responsible for the day-to-day
operation of the NACS and for its overall development.
NACS is the prime data source for the SDS.
NACS Maintains:ƒ
the authoritative national lists for a wide range of NHS
organisations and medical practitioners;
ƒ
the allocation of the NHS standard identification codes
for these organisations and practitioners;
ƒ
a change history record and additional reference data
for these organisations;
ƒ
details of the relationships between these
organisations and practitioners;
ƒ
details of the geographic areas covered by some of
these organisations, defined in terms of postcodes.
ƒ
central allocation of new or revised codes;
ƒ
help, advice and query resolution on the content and
use of the national reference data;
ƒ
development of the NHS standards in this area;
ƒ
further development of the range of national reference
data.
More information: www.connectingforhealth.nhs.uk/
delivery/programmes/spine
____________________________________________________
National Service Desk
The contract for provision of NHS Connecting for Health
Service Desk services (formally Front Line Service Support
- FLSS), were recently awarded to Fujitsu Services Ltd.
The services to be offered as part of the Agreements fall
into two broad categories:
1. Core Services
The core service is a professional national service desk
support, capable of managing all the user support, reports
and incidents that may be associated with national systems
and services (including NHS Care Records Service,
Choose and Book, Electronic Prescriptions Service and
Picture Archiving and Communications Service). It will
meet the support needs of end users and will be fully
available and effective as the range of systems and
services come on stream. This element will replace and
scale up the functions currently provided directly by NHS
Connecting for Health. The solution incorporates industry
best practice and standards for support service
2. Framework Services
In addition, the NHS can utilise the Framework
Arrangement Services. These services are optional and
will provide a contractual framework under which service
desk support for a wider range of IT systems and services
can be obtained from Fujitsu should local NHS
management believe this would offer a better choice
enabling them to deliver better quality of service and/or
value for money in the future. NHS organisations will need
to fund any services they obtain through the Framework
Arrangement Services. This arrangement allows NHS
organisations to take advantage of nationally negotiated
prices.
The contract, valued at £41M for the Core Service will run
for 7 years to 2013. NHS Finance Directors have accepted
the proposition that whilst Connecting for Health (CfH)
would fund the 2006-2007 costs NHS organisations should
meet the costs of the National Service Desk contract on a
continuing basis from April 2007.
Accreditation
Accredited LSDs (Local Service Desks, i.e. those provided
by NHS Trusts etc) still liaise directly with the Local Service
Provider (LSP). Accreditation is a fundamental part of the
strategic way forward with work already underway to revisit
this subject and propose an agreed set of National
Accreditation criteria. This can then be applied consistently
across the organisation by local trust management under
the jurisdiction of CfH Service Management.
Implementation
An NHS Connecting for Health Service Desk
implementation programme has been established which
comprises procurement project personnel for continuity
purposes, NHS Connecting for Health service management
personnel, appointed senior user team business
representatives and appropriate programme resources
from Fujitsu. All parties are actively mobilising for delivery
of the agreed services. A formal period of transition will
shortly commence during which responsibility for the
services currently provided by the National Service Desk
(NSD) in Leeds will be safely transferred to Fujitsu. The
formal handover will not take place until appropriate testing
and business assurance is successfully completed and
agreed acceptance criteria are met.
Following a formal acceptance process, it is anticipated
that transfer of responsibility for the existing national
service desk will occur during late autumn 2006.
Following successful transfer of NSD services, the optional
framework arrangement services will be made available.
More information:
http://nww.connectingforhealth.nhs.uk/servicedesk/
Contact: [email protected].
_______________________________________________
Update on HRGs
Healthcare Resource Groups (HRGs) are standard
groupings of clinically similar treatments, which use
common levels of healthcare resource. They may be
considered as ‘units of currency’ within the health service,
allowing for costings across services. HRGs are a method
for standardising healthcare commissioning across the
country. They improve the flow of finances within – and
sometimes beyond – the NHS.
The existing HRG portfolio is currently under review, with
HRG version 4 being a major revision of existing HRGs
and introducing HRGs to new clinical areas, to support
Payment by Results (PbR). The primary strands of the
current HRG development are:
ƒ
To evaluate the current HRGs for Admitted Patient
Care (HRG v3.5) and Emergency Medicine v3.2. The
project is to undertake a substantial revision of these
HRGs to bring them up-to-date and accurately reflect
the current clinical treatment plans.
ƒ
To develop new HRGs that accurately capture clinical
activity in the NHS, irrespective of setting.
ƒ
To update, and add to, the current version of admitted
patient care HRGs, (HRG v3.5) released in October
2003. The coverage now needs to expand to include
most outpatient activities (and community settings).
HRG v4.0 will be available for costing in 2007 and after 12
months of recording data for tariffs in 2008.
Most HRGs v4.0 will use criteria based on analyses of
actual costs. No national cost data exists below HRG level
yet, but it does exist at some trusts.
Intervention/procedure will not be the only dominant factor
in the new HRGs. Diagnosis is being used as the
dominant coding factor in a growing number, but is still a
minority proportion of the draft HRGs v4.0. It will be
decided on a case-by-case basis for each HRG. There is
evidence from international classifications that diagnosis
can give a more accurate reflection of resource use.
HRG V4
Label
L03.02
Kidney Major Open Procedure
L03.03
Laparoscopic Operations on Kidney and Ureter
Patient
Procedure
1
Procedure
2
A
B
C
M02.5
M02.5
M02.5
Y75.1
Y75.2
Version 4 HRG
assigned if the
only procedures
recorded are those
shown in columns
Procedure 1 and 2
L03.03
L03.02
L03.03
An illustrative example of an HRG
New HRGs will be defined using the best possible data,
even if it lies beyond the existing datasets. If analysis
shows a strong case for using this additional data, it is
feasible and likely that Commissioning Data Sets will be
extended to include it.
HRGs use data classified
Classification (OPCS).
using
the
Intervention
The national intervention classification team has developed
a flexible and up-to-date classification system that reflects
current clinical activity performed in the NHS and meets the
needs of the Payment by Results (PbR) programme. In the
short term this focused on a significant update of OPCS4.2 to create OPCS-4.3 – the first major enhancement in
20 years.
OPCS-4.3 will be released for use in the NHS from 1 April
2006 as detailed in Data Set Change Notice 14/2005.
Contact: [email protected].
More information: www.ic.nhs.uk/casemix; and
www.connectingforhealth.nhs.uk/interventionclassifica
tion.
____________________________________________________
News in Brief
Information Commissioner
The annual report from the Information Commissioner's
Office (ICO) has highlighted the steps that are being taken
to ensure the safety of patients' personal information.
"Never before has the threat of intrusion to people's privacy
been such a risk."
"Data protection provides the
framework. It raises questions about where lines should be
drawn". The nature of the safe keeping of healthcare data
has developed with the "increasingly sophisticated and
easily accessible technology". A copy of the report is
available
from:
http://www.ico.gov.uk/cms/Document
Uploads/annual_report_full_version_2006.pdf
Microsoft Learning Solutions
NHS Trusts can now make substantial savings by
purchasing Microsoft Learning products, at special reduced
rates, directly from Microsoft under Volume Licensing
Agreements with NHS Connecting for Health. The key
Microsoft Learning Solutions (MLS) available under this
scheme include: Premium Technical eLearning courses;
Electronic Reference Libraries, and Microsoft Certified
Professional (MCP) Exams. See: /www.microsoft.com/
learning/mls/. Contact Ian Turner at: [email protected].
Electronic Prescription Service
The rollout of EPS (Electronic Prescription Service) has
achieved so far:
ƒ
Over 600 GP practices “business live” which have
produced more than 2 million EPS scripts
ƒ
1,462 “technically live” pharmacies
ƒ
Approximately 50,000 scripts a day sent and about
1,000 dispensed using EPS (for staff to use the EPS
system) issued nationally
Professor Protti Report
Professor Protti – a leading academic within the health
informatics industry – has produced the latest in his series
of World View Reports. The 11th report in the series
provides an overview of the various initiatives that are
being put in place to benefit patients and providers alike.
The report reveals the importance of patient relationship
management (PRM) and how it can use patient data in the
service offered to patients. "The resulting benefits typically
include improved customer service, reduced medical
errors, better productivity, cost savings and improved
health
outcomes,
to
name
a
few.”
See:
www.connectingforhealth.nhs.uk/worldview/protti11/
CfH Safety Checks
All new products and services being introduced under the
National Programme for IT are subject to a patient safety
assessment. The patient safety assessment process
involves three key steps:
ƒ
products are risk-assessed in the context in which they
will be used
ƒ
a safety case sets out how identified hazards would be
mitigated
ƒ
a safety closure report provides evidence that hazards
have been addressed satisfactorily.
See:
http://www.connectingforhealth.nhs.uk/casestudies/
patientpublic/safety_first.
e-Learning in Healthcare Services
In November 2005 the National Workforce group published
a strategic framework for encouraging and supporting best
practice for the use of e-learning in the NHS. One of the
recommendations was the development of a roadmap,
setting out the sequence and actions that would need to be
taken if the wider adoption of e-learning is to be enabled.
A further report has been recently published which sets out
this roadmap and recommendations for governance
arrangements to enable implementation.
See:
www.nationalworkforce.nhs.uk/documents_library/attachm
ents/national_e-learning_report_ screen_version_final.pdf.
Ensuring Successful Projects
The London & South East branch of ASSIST (the
Association of ICT Professionals in Health) holds its next
event on 12 September 2006. The topic for this event is
“Ensuring Success in Major Projects”. Further information
on ASSIST, this event, and booking forms from:
[email protected].
Choose & Book
Momentum continues to build with the roll-out of Choose
and Book. On 10 July 2006 the number of bookings made
in a single day was 10,638. This is the highest number of
bookings made in a single day to date and compares to an
average of about 6,000 per day at the beginning of May
and 2,000 per day at the end of January.
____________________________________________________
Diary
8–9
Sep 06
BCS Annual Conference: “Being
Heard, Being Understood”
(www.phcsg.org.uk)
12 Sep 06
Conference on the Data Accreditation
Standard (Primary Care), London.
(http://etdevents.connectingforhealth.nhs.uk/)
12 Sep 06
ASSIST: “Ensuring Success in Major
Projects”, London WC2
([email protected])
29 Sep 06
“Clinical Information Systems &
Electronic Records”, London
(www.healthcare.events.co.uk.)
23 Nov 06
Care Records Development Board
Conference
(www.connectingforhealth.nhs.uk/crdb/)
___________________________________________________________
Address for correspondence:
The Go-Between,
c/o David Green, Head of IM&T,
SW London & St George’s Mental
Health NHS Trust, Springfield
University Hospital, Tooting,
LONDON SW17 7DJ
020 8772 5602
[email protected]
London & South East